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coding bx advice

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I am stumped Have a woman on medicare with rash on head I did not recognize  Scalp. bx'd it .It is likely  lichen planus  If you do not  treat hey get scarring and alopecia Mcr will not pay for the bx  Did not occur to be  an abn was needed?

My biller is a coder...and she  doesn't know  How can we  bill this and be paid?  i Never encountered this before!thansk--      MD    

     ph    fax

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